Healthcare Provider Details

I. General information

NPI: 1891823712
Provider Name (Legal Business Name): TERESA ANN NOEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 N DUPREE AVE
BROWNSVILLE TN
38012-1707
US

IV. Provider business mailing address

206 B ST
JACKSON TN
38301-7406
US

V. Phone/Fax

Practice location:
  • Phone: 731-772-3356
  • Fax: 731-772-0531
Mailing address:
  • Phone: 731-772-3356
  • Fax: 731-772-0531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3612
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: